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oF PR� CITY OF PRIOR LAKE BUILDING PERMIT, Date Rec'd
� ; TEMPORARY CERTIFICATE OF ZONING COMPLIANCE .� ` G r Z
v X
AND UTILITY CONNECTION PERMIT
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2 �;�, � PERMIT NO. �?
3 Yellow Applicant
Please or rint and si at bottom)
ADDRESS J ZONING (ot�ice use)
'�L. .�
� � � G �����:� /v ''r v ' �, f
LEGAL DESCRIPTION (ofiice use only)
LOT BLOCK ADDITION PID
OWNER t �� (/ � � C./�
(Name) � (Phone)
(Address)
BUII.,DER _nN T�p/'��" �� S'�"' Phone
(Company Name) �y 6 � �c� r - ( , ��,� /� "05 9 a "' �OC`J �
(Contact Name) �i£tSdil/ �'l'�iLL�Qr/U� (Phone)
(Adaress) Y3L SovTf� Sv7l �'t�£ BL��. J �1�/
TYPE OF WORK ❑ New Construction ❑Deck ❑Porch ❑Re-Roofing ❑Re-Siding ❑Lower Level Finish ❑ Fireplace
❑Addition ❑Alteration ❑Utility Connection
CODE: ❑I.R.C. ❑I.B.C. ❑ Misc.
Type of Constiuction: I II III N V A B pROJECT COST/VALUE S
Occupancy Group: A B E F H I M R S U (excluding land)
Division: 1 2 3 4 5
I hereby certi'ty that I have fiimished information on this application which is to the best uf my knowtedge tnie and correct. 1 also certify that I am the owner or authonzcd agent for the
above-mennoned pro � that all cun iction will conform to all existing state and local laws and will proceed in accordance with submitted plans. I am aware that the buildmg
official can revo is perm' or ju se Furthermore, I hereby agree that the c�ty official or a designee may enter upon the property ro perForm necded mspectiuns.
X ��c. 6 3 9 a 3 0 �o �.�
Contractor's License No. Date
Pe ' aluati Park Support Fee # $
Permit Fee $ SAC # $
Plan Check Fee $ Water Meter Size 5/8"; 1"; $
State Surcharge $ Pressure Reducer $
Penalty $ Sewer/Water Connection Fee # $
Plumbing Permit Fee $ Water Tower Fee # $
Mechanical Permit Fee $ Builder's Deposit $
Sewer & Water Permit Fee $ Other $
Gas Fireplace Permit Fee $ TOTAL DLTE $
This Application Becomes Your Building Permit When Approved Paid Cel t N
Date . ( �
Buildine Ut7iciai Date
Th�s u ro certify that the requcst in thr above applicanon and accumpanying documents is in accordance with thc Ciry Zoning Ordinanc a may protteA as rcqucsted. Thrs document
when signed by the Ciry Piannrr consututes a temporary Certificate of Zoning compliance and allows construction tu commence. Befure occupancy, a Ccrtificate uf Occupancy must be
issucd.
Planning Director Date Special Conditions, if any
24 hour notice for all inspections (952) 447-9850, fax (952) 447-4245
4646 Dakota Street Prior Lake, MN 55372